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I had a contrast CT a week and a half ago and there was no…

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I had a contrast CT...
I had a contrast CT a week and a half ago and there was no fatty infiltration of the pancreas and then had a regular CT a few days ago and it showed fatty infiltration of the pancreatic head... they followed up a few hours later with an MRI and that too showed fatty infiltration of the pancreatic head. I don't have diabetes and am not obese. Thoughts?
Submitted: 4 months ago.Category: Medical
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Answered in 3 minutes by:
12/27/2017
Doctor: Dr. Arun Phophalia, Doctor replied 4 months ago
Dr. Arun Phophalia
Category: Medical
Satisfied Customers: 38,076
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Doctor: Dr. Arun Phophalia, Doctor replied 4 months ago

I am writing the answer for you and will get back to you in 4-5 minutes. If you get a phone call request, you may ignore it as that is an automated site trigger. Thank you.

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Customer reply replied 4 months ago
also... 39 year old female.
Doctor: Dr. Arun Phophalia, Doctor replied 4 months ago

Contrast CT may have obscured the fatty infiltration of the pancreas head which was seen by plain CT and confirmed by MRI.

Clinically this may not be significant at all.

Reports on the relationship between fatty pancreas and β-cell function are inconsistent. Some studies indicate that pancreatic lipid content is negatively associated with insulin secretion in nondiabetic subjects or individuals with prediabetes, while others suggest that there is no relationship between β-cell function and pancreatic fat in prediabetic or diabetic subjects.

Please see the references;

Tushuizen ME, Bunck MC, Pouwels PJ, Bontemps S, van Waesberghe JH, et al. (2007) Pancreatic fat content and beta-cell function in men with and without type 2 diabetes. Diabetes Care 30: 2916–2921[PubMed]

Heni M, Machann J, Staiger H, Schwenzer NF, Peter A, et al. (2010) Pancreatic fat is negatively associated with insulin secretion in individuals with impaired fasting glucose and/or impaired glucose tolerance: a nuclear magnetic resonance study. Diabetes Metab Res Rev 26: 200–205 [PubMed]

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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Doctor: Dr. Arun Phophalia, Doctor replied 4 months ago

What were the reasons for getting contrast CT scan?

As we discussed, a fatty pancreas in a normal weight individual may not be clinically significant.

There may be some people who may have high cholesterol and triglycerides but may have normal body fat and visceral fat. A pancreas fat in some individual may be predictor of;

1) Future fatty liver disease.

2) Predictor of insulin resistance, prediabetes or diabetes in later life.

Please see the reference;

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670415/

An interesting finding of this study is that in a majority of cases (67.9%), fatty pancreas and fatty liver were found concurrently on sonography, and most fatty liver patients (96.9%) also showed fatty pancreas. Although the positive predictive value of fatty liver in fatty pancreas was 69.4%, the negative predictive value of fatty liver in normal pancreas was 96.4%. This implies that fatty pancreas could be used as the initial indicator of ‘ectopic fat deposition’ and as an early marker of insulin resistance, which is a key element of fatty liver and/or metabolic syndrome. More studies will be necessary on the role of fatty pancreas as an early marker of ectopic fat deposition or insulin resistance.

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Customer reply replied 4 months ago
my bloodwork was all normal. Had a CBC and basic panel in the ER.
Doctor: Dr. Arun Phophalia, Doctor replied 4 months ago

You have non obstructing kidney stones.

The pancreas finding is clinically not important in your case.

It is considered as incidental finding.

This does not relate to cancer or any serious issue.

Nothing to worry.

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Customer reply replied 4 months ago
I’ve attavhed the CT with AND without contrast report from last week. Ive also attached the CT (without contrast) from a few days ago. I’ve also attached the MRI from a few days ago.Yes I have two kidney stones...1 is 6mm and the other 7mm. I go into the OR to blast them and put a stent in next week.I’ve had hematuria for the past 4-5 weeks and pain. End of November I went to er for pain and they discovered hematuria and a cyst on my left ovary measuring 1.9 cm. Saw my gyn and she dismissed my pain and said to get another ultrasound in 4-6 weeks. Back in the Er last week for pain and suspected nephritis. The CT (non contrast) and MRI showed focal fatty infiltration of the pancreatic head..no one explained what it is and what it really means.My questions about the focal fatty infiltration of the pancreatic head are 1. My blood work is all normal (including glucose) so I’m not diabetic or prediabetic. 2. Can this focal fatty infiltration of the pancreatic head be reversed with diet and or weight loss? 3. The CT on the 15th was both a reg CT and a contrast CT (attached), so how could this have been missed and now found a week later? 4. Admittedly I ate horribly (fatty foods and high calorie between the two imaging studies)..could that cause this?They also noted a cyst on the left ovary now measuring 3.1cm (4 weeks after the initial finding)... called my gyn and she said to wait 2 weeks (despite persistent twisting pain in lower left abdomen) and said it might just be a new cyst. I’m concerned and frustrated because the pain is constant and feels like twisting and burning. It was suspected based on pain and dezcription of pain in the ER a month ago that it was ovarian torsion. Couldn’t it still be that?Overall in the last 4 weeks I’ve had
- two ER visits, one where I was admitted and on morphine...
- two urology visits.
- two CTs, one MRI, a transvaginal ultrasound and renal ultrasound
- put on Percocet
- five urinalysis showing hematuria each time
- fever of 100.6 a week ago
- absolute exhaustion
- pain in the lower left abdomen (very specific)
- pain and a knot wrapping around my side under my rib cage
- all totally normal blood workPlease read the entire radiology reports I attached.I feel like I’m getting a lot of “wait and see”
Doctor: Dr. Arun Phophalia, Doctor replied 4 months ago

First the answers of your specific questions:

1. My blood work is all normal (including glucose) so I’m not diabetic or prediabetic.

Fatty infiltration of the pancreas head occurs in people who have risk of diabetes and prediabetes. It is a risk predictor. 70% this risk predictor is right and this happen in 30% normal people too who would not develop diabetes.

2. Can this focal fatty infiltration of the pancreatic head be reversed with diet and or weight loss?

Yes this is likely to be reversible with the diet.

3. The CT on the 15th was both a reg CT and a contrast CT (attached), so how could this have been missed and now found a week later?

Reporting errors or missing is not uncommon in radiology. This happens due to thick sections when you are not suspecting anything and 5 mm section may miss it. When you are suspecting something, you may take a thinner section.

4. Admittedly I ate horribly (fatty foods and high calorie between the two imaging studies)..could that cause this?

Food may be responsible for it. But visceral fats are mobile and come and go in some individuals.

The microscopic hematuria is explained by the kidney stones.

Your pain is concerning. Ovarian torsion is likely to be the culprit. Your doctor may consider a scintiscan of the intestines, if you have associated bloating, gas, diarrhea/constipation. This may rule out small intestine diverticulitis.

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Doctor: Dr. Arun Phophalia, Doctor replied 4 months ago

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